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This is VAERS ID 275949

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 275949 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Indiana  
Vaccinated:2007-02-16
Onset:2007-04-09
   Days after vaccination:52
Submitted: 2007-04-10
   Days after onset:1
Entered: 2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC Split Type:

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


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